27331 Arthrotomy, knee; including joint exploration, biopsy, or removal of loose or foreign bodies

Name of the Procedure:

Arthrotomy, Knee

• Common Names: Open Knee Surgery
• Medical Terms: Knee Arthrotomy, Arthrotomy of the Knee Joint

Summary

An arthrotomy of the knee is a surgical procedure involving an open incision into the knee joint to examine, biopsy, or remove loose bodies such as bone fragments or foreign materials. It's typically performed to address joint issues that cannot be managed through less invasive techniques.

Purpose

• Medical Conditions: This procedure is commonly used to treat internal knee issues such as severe arthritis, infections, loose bone fragments, or unexplained pain.
• Goals/Outcomes: The aim is to relieve pain, improve joint function, diagnose underlying conditions, and remove any problematic loose or foreign bodies within the knee joint.

Indications

• Persistent knee pain not relieved by conservative treatments
• Knee joint infection
• Presence of loose bodies or foreign materials detected through imaging
• Suspected joint diseases requiring a biopsy for diagnosis

Preparation

• Pre-Procedure Instructions: Patients may need to fast for several hours before surgery. Medications, especially blood thinners, may need adjustment.
• Diagnostics: Pre-operative imaging (like X-rays or MRI), blood tests, and physical exams will be conducted to plan the procedure.

Procedure Description

1. Incision: The surgeon makes an incision over the knee to access the joint.
2. Exploration: The knee joint is opened, allowing the surgeon to visualize the internal structures.
3. Biopsy/Removal: Any necessary biopsy of synovial tissue is taken, and loose or foreign bodies are removed.
4. Closure: The incision is thoroughly cleaned, stitched closed, and bandaged.

• Tools/Equipment: Scalpel, forceps, surgical scissors, suction devices, biopsy needles.
• Anesthesia: General or regional anesthesia (spinal or epidural) is administered to keep the patient comfortable and pain-free.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity.

Setting

Performed in a hospital or surgical center, typically as an inpatient procedure requiring an overnight stay.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common risks: Infection, bleeding, blood clots, anesthesia reactions
• Rare complications: Nerve damage, persistent pain, joint stiffness, delayed healing

Benefits

• Relief from chronic pain and discomfort
• Improved knee function and mobility
• Accurate diagnosis from biopsies if needed
• Removal of harmful loose bodies or foreign materials

Recovery

• Post-Procedure Care: Rest, icing the knee, pain medications, and physical therapy
• Recovery Time: Generally, 6-8 weeks for initial recovery, with possible longer-term rehabilitation
• Restrictions: Limited weight-bearing on the leg, avoiding strenuous activities
• Follow-Up: Appointments to monitor healing and remove sutures

Alternatives

• Arthroscopic knee surgery (less invasive, but might not be suitable for all cases)
• Conservative treatments (physical therapy, medications, joint injections)
• Pros and Cons: Arthroscopic surgery has a quicker recovery but may not be adequate for severe cases; conservative treatments avoid surgery but may not address the root problem.

Patient Experience

• During Procedure: Under anesthesia, so no pain; potential slight discomfort during recovery room transition.
• Post-Procedure: Pain managed with medication, possible swelling and bruising, physical therapy starts shortly after surgery to aid in recovery.
• Comfort Measures: Use of cold packs, elevation of the knee, and appropriate pain relief medications.

Patients typically experience significant relief once the joint heals, although engaging in follow-up care and rehabilitation is crucial to a successful outcome.